SPEAKER INTAKE FORM Name* First Last PhoneEmail* Completed Speaker SheetIf you already have a "One-sheeter" promo Accepted file types: jpg, png, pdf, jfif, tiff, bmp, bat.Biography*Website- Please list the URL below:Social Media HandlesCheck off then enter url/handles in fields that appear below. Linked In Facebook Business Facebook Personal Twitter Instagram Business Instagram Personal Other Linked InFacebook BusinessFacebook PersonalTwitterInstagram BusinessInstagram PersonalOther Social MediaPlatformURL/handle List video links to your speaking demos (YouTube/Vimeo) Do you have a headshot? Please upload it here: (Keep in mind that all images need to be scaled to 150 pixels wide.)If your image is larger than 150 pixels wide, you can easily go to this site: https://www.befunky.com to "resize" and then upload that smaller version.Accepted file types: jpg, png, pdf, jfif, tiff, bmp, bat.Photo Gallery (If you choose, please add any other supporting images you have of you speaking.): Drop files here or Accepted file types: jpg, png, pdf, jfif, tiff, bmp, bat. Your LOGO-Please upload here: (Please scale image to 150 pixels wide.)Accepted file types: jpg, png, pdf, jfif, tiff, bmp, bat.What are your primary speaking topics? Please list them below:* List previous LIVE/in-person speaking engagements in past 2 years or sample. Include fee received and audience size.* Have you spoken virtually since March 2020 in COVID environment? Include audience, fee received and online size. And link to event if still posted.* What boards (business or non-profit) are you on as an active member? List them here with links to the websites.* Do you have testimonials on your speaking and character? Please describe them below:Please list additional speakers in your field or area of expertise who are “like” you Connections you’d like us to make on your behalf, and/or events at which you’d like to speak. PhoneThis field is for validation purposes and should be left unchanged.